Individual
JORDAN GAVIN HORNIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS, LADC
Contact information
Practice address
1404 CENTRAL AVE NE, MINNEAPOLIS, MN 55413-1517
(612) 594-8146
(612) 789-8087
Mailing address
2552 KENZIE TER APT 128, SAINT ANTHONY, MN 55418-4153
(612) 998-7049
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305535
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NOTHING
NOTHING
—
Enumeration date
10/07/2020
Last updated
10/07/2020
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